Delivering quality public healthcare is a global challenge. ACE is concerned with the barriers health workers often face to provide the care patients need, whilst also prioritising their own gains due to badly designed incentive structures in health systems.
These structures often create individual uses of public resources for private gain. Some obvious examples include diverting patients to private facilities owned by a health worker, charging informal fees, and theft of medicines and equipment. More subtle examples include recommending unnecessary treatment for the health worker’s remuneration or workers simply not turning up for work, whilst still being paid.
The health sector is extremely vulnerable to corruption because of how its systems are established. Many private transactions take place between health professionals and patients, where amounts of information flow not only between patients and health workers but between workers and employers. A lack of accountability allows corrupt practices to flourish, leading to a provision of care that is at best ineffective and at worst harmful to the economic wellbeing of patients, their families and the system.
The consequences of corruption are extremely serious and include lost productivity, job loss and wasteful expenditure. They can extend beyond patients and health workers, to employees and customers in cases of insolvency. Corruption is also a major contributor to impoverishment, because it tends to widen inequalities and impact most on the poor and vulnerable.
Understanding the motivations behind corruption is essential if effective policies and interventions are to be designed. Different interventions including health facility committees, facility score-cards, and public hearings can be also used to achieve public accountability and thus reduce the space for corrupt harmful behaviours in the health sector. ACE is exploring these main lines of research in the health sector across our three countries and multiple levels of governance in health.